title: Early coagulation disorder after allogeneic stem cell transplantation is a strong prognostic factor for transplantation-related mortality, and intervention with recombinant human thrombomodulin improves the outcome: a single-center experience.
abstract: We retrospectively analyzed 60 cases of pediatric patients who received allogeneic stem cell transplantation (SCT) between 2000 and 2008, using the tentative scoring system for evaluation of early (<30 days) coagulation disorders. In the 41 patients who survived, D-dimer levels showed a transient increase 2 weeks after SCT and normalized thereafter, but these levels were persistently elevated in the 19 patients who died. Of 19 patients with a positive score, 11 died of transplantation-related complications [transplantation-related mortality (TRM) = 0.579] within 1 year, while none of the 41 with a negative score died during the same period. Since 2009, 12 of 30 patients had positive scores within 30 days after SCT. Intervention with recombinant human thrombomodulin (rhTM) was introduced for patients with a positive score, and 10 of these patients survived (TRM = 0.167) along with a dramatic improvement of D-dimer level. Although the effects of this treatment were observed in a limited number of patients, our observations suggest that early coagulation disorder after allogeneic SCT is a strong prognostic factor for TRM, and that intervention with rhTM improves TRM.
authors.affiliation: Department of Pediatrics and Developmental Biology, Post Graduate School, Tokyo Medical and Dental University, 5-45 Yushima 1-chome, Bunkyo-ku, Tokyo, 113-8519, Japan, mnagasawa.ped@tmd.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nagasawa
authors.forename: Teppei
authors.initials: T
authors.lastname: Ohkawa
authors.forename: Akifumi
authors.initials: A
authors.lastname: Endo
authors.forename: Noriko
authors.initials: N
authors.lastname: Mitsuiki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ono
authors.forename: Yuki
authors.initials: Y
authors.lastname: Aoki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Isoda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tomizawa
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Takagi
authors.forename: Michiko
authors.initials: M
authors.lastname: Kajiwara
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Morio
authors.forename: Shuki
authors.initials: S
authors.lastname: Mizutani
mesh_terms: D000293:Adolescent; D001777:Blood Coagulation / Q000187:drug effects; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D018180:Thrombomodulin / Q000008:administration & dosage / Q000627:therapeutic use*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D011994:Recombinant Proteins; D018180:Thrombomodulin; C036309:fibrin fragment D